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Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections

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World Journal of Emergency Medicine 2023年第4期14卷 280-286页

作者： Xinlei Wang Yao Sun Xiaoyu Ni Shu Zhang Department of Emergency West China HospitalSichuan UniversityChengdu 610041Chiha

BACKGROUND:Community-acquired bloodstream infections(CABSIs)are common in the emergency departments,and some progress to sepsis and even lead to ***,limited information is available regarding the prediction of patients with high risk of ***:The Emergency Bloodstream Infection Score(EBS)for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve(AUC).The mortality in Emergency Department Sepsis(MEDS),Pitt Bacteremia Score(PBS),Sequential Organ Failure Assessment(SOFA),quick Sequential Organ Failure Assessment(qSOFA),Charlson Comorbidity Index(CCI),and McCabe–Jackson Comorbid Classification(MJCC)for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis(DCA).The net reclassification improvement(NRI)index and integrated discrimination improvement(IDI)index were compared between the SOFA and ***:A total of 547 patients with CABSIs were *** AUC(0.853)of the EBS was larger than those of the MEDS,PBS,SOFA,and qSOFA(all Pin-hospital mortality of CABSIs patients was 0.368(P=0.04),and the IDI index was 0.079(P=0.03).DCA showed that when the threshold probability wasin-hospital mortality of patients with CABSIs.

关键词： Community-acquired bloodstream infection Risk factors in-hospital mortality Emergency department

Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients:A retrospective observational study

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World Journal of Emergency Medicine 2022年第2期13卷 114-119页

作者： Hai Hu Jing-yuan Jiang Ni Yao Emergency Office of West China hospital Sichuan UniversityChengdu 610041China China International Emergency Medical Team Chengdu 610041China Emergency Department West China HospitalSichuan UniversityChengdu 610041China West China School of Nursing Sichuan UniversityChengdu 610041China Department of Critical Care Medicine West China HospitalSichuan UniversityChengdu 610041China

BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis ***,some studies have recently shown its poor performance in sepsis mortality *** enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,*** operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various ***:Among the 936 enrolled cases,there were 835 survivors and 101 *** AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,*** sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,*** specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,*** LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital ***:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to *** the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

关键词： Quick sequential organ failure assessment in-hospital mortality Sepsis Lactate-enhanced qSOFA Modified qSOFA

Association between ICU quality and in-hospital mortality of V-V ECMO-supported patients—the ECMO quality improvement action(EQIA)study:a national cohort study in China from 2017 to 2019

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Frontiers of Medicine 2024年第2期18卷 315-326页

作者： Wei Cheng Jieqing Chen Xudong Ma Jialu Sun Sifa Gao Ye Wang Longxiang Su Lu Wang Wei Du Huaiwu He Yujie Chen Zunzhu Li Qi Li Jianhua Sun Hongbo Luo Jinbang Liu Guangliang Shan Bing Du Yanhong Guo Dawei Liu Chang Yin Xiang Zhou on behalf of the China National Critical Care Quality Control Center-the ECMO quality improvement action(EQIA)study Department of Critical Care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing100730China Information Center Department/Department of Information Management State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing100730China Department of Medical Administration National Health Commission of the People’s Republic of ChinaBeijing100044China School of Population Medicine and Public Health Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China Department of Epidemiology and Biostatistics Institute of Basic Medicine SciencesChinese Academy of Medical Sciences(CAMS)&School of Basic MedicinePeking Union Medical CollegeBeijing100730China National Institute of hospital Administration National Health Commission of the People’s Republic of ChinaBeijing100044China 不详

This cohort study was performed to explore the influence of intensive care unit(ICU)quality on in-hospital mortality of veno-venous(V-V)extracorporeal membrane oxygenation(ECMO)-supported patients in *** study involved all V-V ECMO-supported patients in 318 of 1700 tertiary hospitals from 2017 to 2019,using data from the National Clinical Improvement System and China National Critical Care Quality Control *** quality was assessed by quality control indicators and capacity *** the 2563 V-V ECMO-supported patients in 318 hospitals,a significant correlation was found between ECMO-related complications and *** reintubation rate within 48 hours after extubation and the total ICU mortality rate were independent risk factors for higher in-hospital mortality of V-V ECMO-supported patients(cutoff:1.5%and 7.0%;95%confidence interval:1.05–1.48 and 1.04–1.45;odds ratios:1.25 and 1.23;P=0.012 and P=0.015,respectively).Meanwhile,the V-V ECMO center volume was a protective factor(cutoff of≥50 cases within the 3-year study period;95%confidence interval:0.57–0.83,odds ratio:0.69,P=0.0001).The subgroup analysis of 864 patients in 11 high-volume centers further strengthened these ***,ICU quality may play an important role in improving the prognosis of V-V ECMO-supported patients.

关键词： veno-venous extracorporeal membrane oxygenation in-hospital mortality high-volume centers quality control intensive care unit capacity parameters

SinoSCORE:a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

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Frontiers of Medicine 2013年第4期7卷 477-485页

作者： Zhe Zheng Lu Zhang Xi Li Shengshou Hu behalf of the Chinese CABG Registry Study Department of Cardiovascular Surgery and State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China 不详

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery(CABG).Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese Coronary Artery Bypass Grafting *** database was randomly divided into developmental and validation subsets(9:1).The data in the developmental dataset were used to develop the model using logistic *** and discrimination characteristics were assessed using the validation *** were defined for each model to distinguish different risk *** excluding 275 patients with incomplete information,the overall mortality rate of the remaining 9564 patients was 2.5%.The SinoSCORE model was constructed based on 11 variables:age,preoperative NYHA stageⅢorⅣ,chronic renal failure,extracardiac arteriopathy,chronic obstructive pulmonary disease,preoperative atrial fibrillation or flutter(within 2 weeks),left ventricular ejection fraction,other elective surgery,combined valve procedures,preoperative critical state,and *** the developmental dataset,calibration using a Hosmer-Lemeshow(HL)test was at P=0.44 and discrimination based on the area under the receiver operating characteristic curve(ROC)was *** the validation dataset,the HL test was at P=0.34 and the area under the ROC(AUC)was 0.78.A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

关键词： coronary artery bypass grafting risk stratification in-hospital mortality

Patterns of in-hospital mortality and bleeding complications following PCI for very elderly patients： insights from the Dartmouth Dynamic Registry

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Journal of Geriatric Cardiology 2018年第2期15卷 131-136页

作者： Shawn X Li Hannah I Chaudry Jiyong Lee Theodore B Curran Vishesh Kumar Kendrew K Wong Bruce W Andrus James T DeVries Dartmouth Geisel School of Medicine Hanover NH USA Department of Internal Medicine Dartmouth-Hitcheock Medical Center Lebanon NH USA Section of Cardiovascular Medicine Dartmouth-Hitchcock Medical Center Lebanon NH USA

Background Very elderly patients （age 〉 85 years） are a rapidly increasing segment of the population. As a group, they experience high rates of in-hospital mortality and bleeding complications following percutaneous coronary intervention （PCI）. However, the relationship between bleeding and mortality in the very elderly is unknown. Methods Retrospective review was performed on 17,378 consecutive PCI procedures from 2000 to 2015 at Dartmouth-Hitchcock Medical Center. Incidence of bleeding during the index PCI admission （bleeding requiring transfusion, access site hematoma 〉 5 cm, pseudoaneurysm, and retroperitoneal bleed） and in-hospital mortality were reported for four age groups （〈 65 years, 65-74 years, 75-84 years, and ≥ 85 years）. The mortality of patients who suffered bleeding complications and those who did not was calculated and multivariate analysis was performed for in-hospital mortality. Lastly, known predictors of bleeding were compared between patients age 〈 85 years and age ≥85 years. Results Of 17,378 patients studied, 1019 （5.9%） experienced bleeding and 369 （2.1%） died in-hospital following PCI. Incidence of bleeding and in-hospital mortality increased monotonically with increasing age （mortality： 0.94%, 2.27%, 4.24% and 4.58%; bleeding： 3.96%, 6.62%, 10.68% and 13.99% for ages 〈 65, 65-4, 75-84 and ≥ 85 years, respectively）. On multivariate analysis, bleeding was associated with increased mortality for all age groups except patients age ≥85 years [odds ratio （95% CI）： age 〈 65 years, 3.65 （1.99-6.74）; age 65-74 years, 2.83 （1.62-4.94）; age 75-84 years, 3.86 （2.56-5.82）, age ≥ 85 years 1.39 （0.49-3.95）]. Conclusions Bleeding and mortality following PCI increase with increasing age. For the very elderly, despite high rates of bleeding, bleeding is no longer predictive of in-hospital mortality following PCI.

关键词： Complications in-hospital mortality Percutaneous coronary intervention The elderly

Prognostic Value of Neutrophil to Lymphocyte Ratio for in-hospital mortality in Elderly Patients with Acute Myocardial Infarction

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Current Medical Science 2018年第2期38卷 354-359页

作者： Tang-meng GUO Bei CHENG Li KE Si-ming GUAN Ben-ling QI Wen-zhu LI Bin YANG Department of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China Institute of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China

Coronary artery disease （CAD） is a multifactorial disease in which inflammation plays a central role. This study aimed to investigate the association of inflammatory markers such as the neutrophil to lymphocyte ratio （NLR）, the Global Registry of Acute Coronary Events （GRACE） score with in-hospital mortality of elderly patients with acute myocardial infarction （AMI） in an attempt to explore the prognostic value of these indices for elderly AMI patients. One thousand consecutive CAD patients were divided into two groups based on age 60. The laboratory and clinical characteristics were assessed retrospectively by reviewing the medical records. The NLR and GRACE score were calculated. In the elderly （〉60 years）, patients with non-ST-elevation myocardial infarction （NSTEMI） and ST-elevation myocardial infarction （STEMI） had significantly higher NLR than did those with unstable angina （UA） and stable angina pectoris （SAP）（P〈0.01）. The NLR was considerably elevated in older AMI patients compared with their younger counterparts （〈60 years）（P〈0.05）. In elderly AMI patients, the NLR was considerably higher in the high-risk group than in both the low-risk and mediumrisk groups based on the GRACE score （P〈0.05 and P〈0.01, respectively）, and the NLR was positively correlated with the GRACE score （r=0.322, P〈0.001）. Either the NLR level or the GRACE score was significantly higher in the death group than in the surviving group （P〈0.05）. By curve receiver operator characteristic curve （ROC） analysis, the optimal cut-off levels of 9.41 for NLR and 174 for GRACE score predicted in-hospital death [ROC area under the curve （AUC） 0.771 and 0.787, respectively, P〈0.001]. It was concluded that an elevated NLR is a potential predictor of in-hospital mortality in elderly patients with AMI.

关键词： neutrophil to lymphocyte ratio in-hospital mortality coronary artery disease elderly patients

Regional heterogeneity of in-hospital mortality of COVID-19 in Brazil

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Infectious Disease Modelling 2022年第3期7卷 364-373页

作者： Yuan Liu Kexin Wang Lin Yang Daihai He Department of Applied Mathematics Hong Kong Polytechnic UniversityHong KongChina School of Nursing Hong Kong Polytechnic UniversityHong KongChina

Background The ongoing Coronavirus disease of 2019(COVID-19)pandemic has hit Brazil hard in period of different dominant *** COIVD-19 variants have swept through the region,resulting that the total number of cases in Brazil is the third highest in the *** study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social *** We fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27,2020 to March 15,*** in-hospital mortality risks of vaccinated and unvaccinated patients were compared,with adjustment for age,state,ethnicity,education and *** the effects of variables to in-hospital mortality were also *** analysis was conducted across different age groups and vaccine *** By fitting the multivariate mixed-effects Cox model,we concluded that age was the most important risk factor for *** regards to educational level,illiterate patients(hazard ratio:1.63,95%CI:1.56–1.70)had a higher risk than those with a university or college *** common comorbidities were more dangerous for hospitalized patients,such as liver disease(HR:1.46,95%CI:1.34–1.59)and immunosuppression(HR:1.32,95%CI:1.26–1.40).In addition,the states involving Sergipe(HR:1.75,95%CI:1.46–2.11),Roraima(HR:1.65,95%CI:1.43–1.92),Maranhão(HR:1.57,95%CI:1.38–1.79),Acre(HR:1.44,95%CI:1.12–1.86),and Rondônia(HR:1.26,95%CI:1.10–1.44)in the north and the northeast region tended to have higher hazard ratios than other *** terms of vaccine protection,vaccination did not significantly reduce mortality among hospitalized *** and AstraZeneca offered different protection in different regions,and no vaccine provided high protection in all *** The study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil

关键词： COVID-19 in-hospital mortality Vaccine Brazil

A Risk Prediction Model for in-hospital mortality in Patients with Suspected Myocarditis

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Chinese Medical Journal 2017年第7期130卷 782-790页

作者： Duo Xu Ruo-Chi Zhao Wen-Hui Gao Han-Bin Cui Department of Cardiology Ningbo First Hospital Ningbo Zhejiang 315010 China Department of Cardiology CHC International Hospital Cixi Zhejiang 315310 China Department of Cardiology Ningbo First Hospital Ningbo Zhejiang 315010 China Department of Cardiology Ningbo Yinzhou No.2 Hospital Ningbo Zhejiang 315100 China

Background：Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some ***,little is known about the predictors of in-hospital mortality in patients with suspected ***,the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction ***：A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First hospital between January 2003 and December 2013.A total of 238 males （59%） and 165 females （41%） were enrolled in this *** divided the above patients into two subgroups （survival and nonsurvival）,according to their clinical in-hospital *** maximize the effectiveness of the prediction model,we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis,based on data pertaining to previously established risk factors and basic patient *** subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression ***,we identified the independent risk factors for in-hospital mortality using our risk prediction ***：The following prediction model for in-hospital mortality in patients with suspected myocarditis,including creatinine clearance rate （Ccr）,age,ventricular tachycardia （VT）,New York Heart Association （NYHA） classification,gender and cardiac troponin T （cTnT）,was established in the study：P =ea/（1 ＋ ea）（where e is the exponential function,P is the probability of in-hospital death,and a =-7.34 ＋ 2.99× [Ccr 〈60 ml/min =1,Ccr ≥60 ml/min =0] ＋ 2.01 × [age ≥50 years =1,age 〈50 years =0] ＋ 1.93 × [VT =1,no VT =0] ＋ 1.39 × [NYHA ≥3 =1,NYHA 〈3 =0] ＋ 1.25 × [male =1,female =0] ＋ 1.13 × [cTnT ≥50 μg/L 1,cTnT 〈50 μg/L =0]）.The area under the receiver

关键词： in-hospital mortality Logistic Model Myocarditis Risk Factors

Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

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Chinese Medical Journal 2014年第17期127卷 3077-3081页

作者： Hasan Gungor Cemil Zencir Abraham Samuel Babu Cagdas Akgullu Ufuk Eryilmaz All Zorlu Mithat Selvi Sevil Onay Tunay Kurtoglu Department of Cardiology Adnan Menderes University Aydin Turkey Department of Physiotherapy School of Allied Health Sciences Manipal University Karnataka India Department of Cardiology Cumhuriyet University Sivas Turkey Department of Cardiovascular Surgery Adnan Menderes University Aydin Turkey

Background Outcomes in patients requiring coronary artery bypass graft （CABG） surgery have been improved with devices such as the intra-aortic balloon pump （IABP）.Good coronary collateral circulation （CCC） has been shown to reduce mortality in patients with coronary artery disease （CAD）.We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP *** Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was *** Twenty-seven patients had poor CCC and 28 patients had good ***-hospital mortality rate in poor CCC group was significantly higher than good CCC group （14 （50％） vs.4 （13％）,P=0.013）.Preoperative hemoglobin level （OR：0.752; 95％ CI,0.571-0.991,P=0.043）,chronic obstructive pulmonary disease （OR：6.731; 95％ CI,1.159-39.085,P=0.034） and poor CCC grade （OR：5.750; 95％ CI,1.575-20.986,P=0.008） were associated with post-CABG in-hospital *** CCC grade （OR：4.853; 95％ CI,1.124-20.952,P=0.034） and preoperative hemoglobin level （OR：0.624; 95％ CI,0.476-0.954,P=0.026） were independent predictors of in-hospital mortality after *** Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

关键词： coronary collateral circulation coronary artery bypass graft surgery intra-aortic balloon pump in-hospital mortality